Psychotische symptomen bij ontregelde insulineafhankelijke diabetes mellitus: gedwongen opname vermijdbaar?

Abstract

Psychotic symptoms in dysregulated insulin-dependent diabetes mellitus: could coercive hospitalisation have been avoided? This case report describes the medical history of a 64-year-old man brought to the emergency department in a combined psychotic and delirious state due to dysregulated diabetes mellitus (DM). Because of the prominent psychotic symptoms, he was hospitalised in the psychiatric ward. Compliance was compromised as the patient, being under satanic influence, had delusional thoughts of the psychiatric staff. His blood sugar dysregulated further and the patient needed to be transferred to the diabetology department, where he showed good compliance. His blood sugar was regulated and the patient could leave the diabetology department, although the psychotic symptoms persisted. Retransfer to the psychiatric ward was suggested. Because of aggressive acting-out, coercive hospitalisation was proposed. He was transferred to another hospital for a second psychiatric expertise, where he agreed with the proposed antipsychotic treatment and a psychiatric hospitalisation. Consequentially, a coercive hospitalisation was no longer indicated. One day later, he was discharged and the psychotic symptoms resolved shortly after. The correlation between psychosis and dysregulated DM is discussed and the demand for coercive measures re-examined. If the symptoms had been considered as part of an integrated health problem, allowing the patient to continue his stay on the diabetology department, the demand for coercive measures could have been avoided.